A case of primary lung carcinoma solitarily metastasizing to the third ventricle

Abstract

Background: Solitary metastasis of tumors to the third ventricle is very rare and difficult to treat. Diagnostic and secondary treatment considerations are therefore important to improve outcomes.Case DescriptionA 51-year-old healthy male with disorientation, drowsiness, and incontinence was found to have a third ventricular tumor with intratumoral hemorrhage triggering the hypothalamic disorder. The patient also had bullae in the bilateral lung attributed to prolonged smoking. An endoscopic biopsy of the third ventricle tumor was performed. The pathological diagnosis was uncertain because of sampling error. Three weeks later, an emergency craniotomy was performed due to rapid tumor growth. The tumor was reddish, elastic, hard, and strongly adhered to the ventricular wall. It was removed with the third ventricle bottom. The optic recess and optic chiasma were found to be intact. The tumor was considered to originate from the hypothalamus. Hematoxylin and eosin staining revealed atypical growth in the sheet form. Immunohistochemical analysis for cytokeratin7, cytokeratin20, and vimentin confirmed the diagnosis of a metastatic tumor, with strong positive results for programmed cell death 1- ligand 1. Fluorodeoxyglucose positron emission tomography showed high accumulation consistent with a bulla-like lesion. The patient could not receive treatment with immune checkpoint inhibitors due to poor general condition and died three months following surgery due to tumor recurrence. Conclusions: We report a case of primary lung carcinoma solitarily metastasizing to the third ventricle in a 51-year-old individual. Death outcome could be attributed to difficulties in total excision and the poor general condition caused by the hypothalamic disorder and warrants consideration for control of hydrocephalus and hypothalamic functions.

Keywords

• Lung carcinoma
• Solitary metastasis
• Third ventricle